Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level

Eijiro Okada, Kentaro Shimizu, Masanori Kato, Kentaro Fukuda, Shinjiro Kaneko, Jun Ogawa, Mitsuru Yagi, Nobuyuki Fujita, Osahiko Tsuji, Satoshi Suzuki, Narihito Nagoshi, Takashi Tsuji, Masaya Nakamura, Morio Matsumoto, Kota Watanabe

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. Methods: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). Results: Neurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). Conclusion: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.

Original languageEnglish
Pages (from-to)393-399
Number of pages7
JournalJournal of Orthopaedic Science
Volume24
Issue number3
DOIs
Publication statusPublished - 01-05-2019

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Diffuse Idiopathic Skeletal Hyperostosis
Spinal Fractures
Wounds and Injuries
Spine
Ankylosis
Spinal Injuries
Thoracic Injuries
Delayed Diagnosis
Osteogenesis
Thorax
Intervertebral Disc
Spinal Cord Injuries
Multicenter Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Okada, Eijiro ; Shimizu, Kentaro ; Kato, Masanori ; Fukuda, Kentaro ; Kaneko, Shinjiro ; Ogawa, Jun ; Yagi, Mitsuru ; Fujita, Nobuyuki ; Tsuji, Osahiko ; Suzuki, Satoshi ; Nagoshi, Narihito ; Tsuji, Takashi ; Nakamura, Masaya ; Matsumoto, Morio ; Watanabe, Kota. / Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis : Clinical characteristics by fracture level. In: Journal of Orthopaedic Science. 2019 ; Vol. 24, No. 3. pp. 393-399.
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title = "Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level",
abstract = "Background: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. Methods: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2{\%}), 25 thoracic (54.3{\%}), and 14 lumbar (30.4{\%}) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). Results: Neurological status immediately after the cervical-spine injury was C (28.6{\%}) or E (71.4{\%}); after thoracic injury, C (12.0{\%}) or E (88.0{\%}); and after lumbar injury, D (21.4{\%}) or E (78.6{\%}). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3{\%} of the cervical injuries, 80.0{\%} of the thoracic injuries, and 50.0{\%} of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7{\%}). Posterior-column ankylosis was observed in 14.3{\%} of the cervical-fracture group, 72.0{\%} of the thoracic-fracture group, and 78.6{\%} of the lumbar-fracture group (P = .008). Conclusion: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.",
author = "Eijiro Okada and Kentaro Shimizu and Masanori Kato and Kentaro Fukuda and Shinjiro Kaneko and Jun Ogawa and Mitsuru Yagi and Nobuyuki Fujita and Osahiko Tsuji and Satoshi Suzuki and Narihito Nagoshi and Takashi Tsuji and Masaya Nakamura and Morio Matsumoto and Kota Watanabe",
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Okada, E, Shimizu, K, Kato, M, Fukuda, K, Kaneko, S, Ogawa, J, Yagi, M, Fujita, N, Tsuji, O, Suzuki, S, Nagoshi, N, Tsuji, T, Nakamura, M, Matsumoto, M & Watanabe, K 2019, 'Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level', Journal of Orthopaedic Science, vol. 24, no. 3, pp. 393-399. https://doi.org/10.1016/j.jos.2018.10.017

Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis : Clinical characteristics by fracture level. / Okada, Eijiro; Shimizu, Kentaro; Kato, Masanori; Fukuda, Kentaro; Kaneko, Shinjiro; Ogawa, Jun; Yagi, Mitsuru; Fujita, Nobuyuki; Tsuji, Osahiko; Suzuki, Satoshi; Nagoshi, Narihito; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Watanabe, Kota.

In: Journal of Orthopaedic Science, Vol. 24, No. 3, 01.05.2019, p. 393-399.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis

T2 - Clinical characteristics by fracture level

AU - Okada, Eijiro

AU - Shimizu, Kentaro

AU - Kato, Masanori

AU - Fukuda, Kentaro

AU - Kaneko, Shinjiro

AU - Ogawa, Jun

AU - Yagi, Mitsuru

AU - Fujita, Nobuyuki

AU - Tsuji, Osahiko

AU - Suzuki, Satoshi

AU - Nagoshi, Narihito

AU - Tsuji, Takashi

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Watanabe, Kota

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Background: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. Methods: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). Results: Neurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). Conclusion: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.

AB - Background: Diffuse idiopathic skeletal hyperostosis (DISH) makes the spine prone to unstable fractures with neurological deterioration. This study was conducted to assess clinical and radiographic features of spinal fractures in DISH by the level of spinal injury, and to evaluate the optimal treatment for each level. Methods: A multicenter retrospective study over a 5-year period, including 46 patients (35 males; 11 females) with a mean age of 77.2 ± 9.7 years at the time of injury. By fracture level, there were 7 cervical (15.2%), 25 thoracic (54.3%), and 14 lumbar (30.4%) fractures. We recorded the cause of injury, whether diagnosis was delayed, and neurological status by Frankel grade. Ossification and fracture patterns were assessed by CT-multi-planar reconstruction (MPR). Results: Neurological status immediately after the cervical-spine injury was C (28.6%) or E (71.4%); after thoracic injury, C (12.0%) or E (88.0%); and after lumbar injury, D (21.4%) or E (78.6%). Inability to walk at admission was more frequent in patients with a spinal-cord injury above the lumbar level (P = .033). Vertebral-body fractures were observed in 14.3% of the cervical injuries, 80.0% of the thoracic injuries, and 50.0% of the lumbar injuries (P = .004). Most patients with a cervical fracture had a disc-level fracture (85.7%). Posterior-column ankylosis was observed in 14.3% of the cervical-fracture group, 72.0% of the thoracic-fracture group, and 78.6% of the lumbar-fracture group (P = .008). Conclusion: Ossification and fracture patterns in patients with DISH varied distinctly by the level of spinal injury. Intervertebral-disc fractures were frequently observed in the cervical spine. Delayed diagnosis, vertebral-body fracture, and posterior-column ankylosis were observed in the thoracolumbar spine. This study recommends 3 above and 3 below fusion, to avoid instrumentation failure in the fixation of spinal fracture in patients with DISH.

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